Objective: To evaluate the clinical usefulness of PKG Movement Recording System in the assessment process to aid recognition and understanding of tremor in patients with Parkinson’s disease (PD).

Background: PD is a progressive neurological condition, with key motor features of bradykinesia, rigidity, postural instability and tremor. While patients may consider tremor to be a troubling factor, they can have difficulty describing it in the clinical setting. Tremor assessment tools have limitations (1) and suggesting effective management strategies can be challenging.  PKG is a wrist worn data logger reporting on motor features, including presence of tremor. PKG could facilitate consideration of tremor in relation to other motor features and the patient’s reported symptoms.

Methods: In this ongoing project, 3 Parkinson’s Disease Nurse Specialists (PDNS) from primary and secondary care settings will review 60 PD patients, who are experiencing upper limb tremor and who meet approved criteria for PKG. The data logger will be worn for 6 days and the report reviewed by the PDNS in each centre. PDNSs and patients will complete pre and post PKG questionnaires to identify information that may improve understanding of tremor and its relationship to other PD symptoms.

Results: To date 6 patients, (50% male, mean age 70.2 years ± 9.1, mean disease duration 5.5 ± 4.8 years, and a median Hoehn & Yahr 2.5 range 2-4) have been reviewed. The majority reported no obvious pattern with their tremor, except worse when anxious. In 50% of reports, PKG identified tremor around time of medication. Only a third had found a strategy to help alleviate tremor. Patients agreed that the PKG had facilitated communication and understanding of their tremor, and how it might be affected by other factors such as timing of medication and degree of bradykinesia.

Conclusions: Preliminary results of this on-going project suggest that PKG may be a useful tool in establishing a clearer clinical picture in relation to the frequency and duration of tremor and any association with other motor symptoms. This could facilitate more effective communication with patients and we are now continuing with this project

References:

1. Elble R, Bain P, Forjaz MJ, Haubenberger D, Testa C, Goetz CG, Leentjens AF, Martinez-Martin P, Pavy-Le Traon A, Post B, Sampaio C, Stebbins GT, Weintraub D, & Schrag A (2013) Task force report: Scales for screening and evaluating tremor: Mov Disord, 526 28, 1793-1800.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-service-evaluation-of-the-clinical-use-of-parkinsons-kinetigraph-pkg-movement-recording-system-in-the-assessment-of-parkinsons-disease-patients-with-tremor/